The Art of Midwifery Improv’d

During the fall 2013 semester, Hunter College students in Professor Daniel Margocsy’s undergraduate seminar, Health and Society in Early Modern Europe, 15001800, visited NYAM several times to talk about rare anatomical books. Each student then studied one text in depth, learned about its bibliographical and historiographical context, and wrote a blog post about that item. We are pleased to feature two of the blog posts from the class, one this week and one next, both on books from our collections relating to midwifery.

By Sarah Hatoum

The Discovery

Title page to The Art of Midwifery, Improv'd.

Title page to The Art of Midwifery, Improv’d. Click to enlarge.

In the eighteenth century, the field of obstetrics enjoyed an influx of novel scientific observations about birth and innovations aiding the process of birth. Dutch physician Hendrik van Deventer, author of The Art of Midwifery Improv’dwas the first to give a thorough description of the pelvis and was the first to suggest that the shape and size of the pelvic bone could cause difficulty in birth (e.g. if the pelvis were too narrow, usually due to rickets—the softening and deformation of bones caused by malnutrition—a child could not be born).1 Van Deventer asserted that determining the shape and size of a pregnant woman’s pelvis and being familiar with the relationship of the fetus and pelvic bones were essential for a midwife to carry out a safe delivery. 2

In the preface of Van Deventer’s instructive, detailed, and “beautifully calf-bound octavo volume” The Art of Midwifery Improv’d,3 translated from Dutch and Latin into English in 1716, an “Eminent Physician” briefly praises the works of contemporary French physicians such as the skilled man-midwife Francois Mariceau but ultimately remarks that Van Deventer’s The Art of Midwifery Improv’d is “more perfect, more easy, better founded, and extend[s] to more Cases” than other physicians’ works.4

While this was a lofty claim, it was true that prior to Van Deventer there had been little attention paid to the structure of the pelvis. Dr. H. L. Houtzager suggests two reasons for this lack of attention prior to the eighteenth century. Since there was an accepted belief that fetuses were born “by their own strenuous efforts,” there was no reason to blame the bony structure of the pelvis for the death of a fetus. The second reason was that people did not often challenge the Hippocratic paradigm (named after the ancient Greek father of medicine, Hippocrates) that suggested that pelvic bones completely separated during birth. Van Deventer determined that the pelvis was essentially “rigid and had only one mobile part—the coccyx.” Again, following the Hippocratic idea, there would also be no cause to suggest that the pelvis could cause a malformed or fatal birth.5

The Journey

Van Deventer was born in the Netherlands in 1651, during a Dutch golden age. In his early adulthood, Van Deventer moved to Germany and joined an orthodox Protestant sect, the Labadists. Van Deventer was in good company, for two notable women, religious writer Anna Maria van Schurman and the natural-philosophical artist Maria Sibylla Merian, had also belonged to the sect.7 Van Deventer became a mentee to the parish’s medical assistant and eventually became the community’s private physician, surgeon, and man-midwife (he later wrote, five years before his death in 1724, “I have already been delivering babies for roughly forty years…”).8 Van Deventer’s time as the head physician of the Labadist community allowed him to gain hands-on experience in certain fields of medicine, most particularly, orthopedics. The Labadists maintained an ascetic diet often resulting in a vitamin D deficiency that led to bone deformation. Van Deventer thus became proficient in the field of orthopedics, invented instruments to correct bone deformities in adults as well as infants,9 and even treated the King of Denmark, Christian V, for rickets.10

In 1694, the central college of doctors in The Hague denied Van Deventer membership because he did not have the proper background (i.e. he had not studied classical Latin). As a result, he moved to Voorburg (where philosopher Baruch Spinoza lived in the 1660s and worked on his magnum opus Ethics), which was not under the Hague’s jurisdiction, allowing Van Deventer free reign; it is here that he began to educate midwives. Several years later, as a middle-aged man, Van Deventer was finally allowed to officially practice as a physician in The Hague.11

Words of Wisdom

Van Deventer applied his orthopedic knowledge to obstetrics and was the first to focus on physical structure of the pelvis and its importance in The Art of Midwifery Improv’d. The question of why Van Deventer decided to write this book as well as why he became interested in obstetrics could be because of his religious fervor. In The Art of Midwifery Improv’d, there is an emphasis on a safe, natural (i.e. without the use of forceps) deliveries because of his belief that a child is made in the image and likeness of God. Furthermore, the work concludes with an Amen. His handbook acts as a prayer for the preservation of the lives of God’s creations. Perhaps Van Deventer’s challenge of the widely accepted Hippocratic paradigm was a testament to Van Deventer’s religious conviction, and he saw himself as a martyr in the name of perfecting the art of the birth of a child made in God’s image.

Plate 4, with figures showing shows the relation of a certain position of the fetus to the pelvis. Click to enlarge.

Plate 4, with figures showing shows the relation of a certain position of the fetus to the pelvis. Click to enlarge.

Van Deventer held midwives in high esteem and was unlike some of his contemporaries who preferred “man-midwives” to female midwives. Man-midwives, from the seventeenth century onward, were fighting to gain supremacy over female midwives and believed that female midwives were “ignorant meddlers whose arrogance prevented them from calling for male assistance” and that they “lacked a theoretical comprehension of childbirth.” 12 Van Deventer was probably a supporter of female midwives because his wife was a midwife, practiced with him and may have contributed to innovative medical discoveries.13

Figure 5, Number 1 shows a placenta for a single infant. Number 2 shows a placenta for twins.

Figure 5, number 1 (bottom) shows a placenta for a single infant. Number 2 (top) shows a placenta for twins. Click to enlarge.

Many man-midwives such as Mauriceu were “confined within the horizon of traditional obstetric surgery” which Wilson ascribes to a focus on handling a dead child rather than a live one.14 Van Deventer instead focused on providing a safe delivery. He gave detailed advice that would allow midwives to perform a safe and efficient birth. First and foremost, he wrote, midwives should have knowledge of female anatomy. Thenceforth, Van Deventer wrote, midwives should know:

  • How to handle patient and child
  • How to deal with afterbirth (the placenta discharged after birth)
  • How to respond to infants positioned awkwardly in the womb during birth
  • General birth preparation
  • How to offer emotional support post-birth to mother and child15

Unlike many of his predecessors, Van Deventer’s work featured accurate illustrations of the pelvis, seen in Figure 1 below:

Figure 1: The pelvis.

Figure 1: The pelvis. Click to enlarge.

The Art of Midwifery Improv’d brought forth important ideas that had not been studied prior to its publication— particularly the importance of the pelvic bone in birth. Hendrik van Deventer laid the groundwork for a focus on orthopedics within the field of obstetrics. Safer deliveries of children and a better understanding of the process of birth came through his advice to midwives.

References

1. John Byers, “The Evolution of Obstetric Medicine,” The British Medical Journal 1, no. 2685, 15 June 1912, 1347.

2. H. L. Houtzager,“The Commemoration of the Birthday of H. Van Deventer,” Vesalius 7, 2001, 17.

3. Byers, 1347.

4. Hendrik van Deventer, The Art of Midwifery Improv’d, (London, 1716): 4.

5. Adrian Wilson, The Making of Man-midwifery: Childbirth in England, 1660-1770, (Cambridge, Massachusetts: Harvard University Press, 1995), 56 and Houtzager, 16-17.

6. L. J. Benedek-Jaszmann, “The Silversmith Who Became the Co-Founder of Modern Obstetrics,” 1980, 243.

7. Wilson, 80.

8. Qtd. in Peter M. Dunn, “Hendrik van Deventer (1651-1724) and the Pelvic Birth Canal,” Perinatal Lessons from the Past, 1998.

9. Byers, 1347.

10. Jaszmann, 243.

11. R. M. F. van der Weiden and W. J. Hoogsteder, “A New Light upon Hendrik van Deventer (1651-1724): Identification and Recovery of a Portrait,” Journal of the Royal Society of Medicine 90, October 1997.

12. Lianne McTavish. Childbirth and the Display of Authority in Early Modern France, (International Ltd., 2005).

13. Wilson, 80.

14. Wilson, 56.

15. Van Deventer, 14.

2 thoughts on “The Art of Midwifery Improv’d

  1. Pingback: Angelique Marguerite Le Boursier du Coudray’s Abrégé de l’art des accouchements | Books, Health and History

  2. Reblogged this on Medical Library Matters and commented:
    This blog from the New York Academy of Medicine fits in with Medical Library Matters. Midwives are an important group within the Medical Library users, both midwifery students and qualified midwives.

    I’m sure they’d be amused to think that ‘the pelvic bones separate during childbirth, or that the fetus is born through it’s own strenuous efforts!!

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